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official publication of SDCMS May 2016

— page 14

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May 2016




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Volume 103, Number 5

EDITOR: James Santiago Grisolía, MD MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Sherry L. Franklin, MD • James Santiago Grisolía, MD • Theodore M. Mazer, MD • Robert E. Peters, MD, PhD • David M. Priver, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: William T-C Tseng, MD, MPH (CMA Trustee) President-elect: Mihir Y. Parikh, MD Secretary: Mark W. Sornson, MD Treasurer: David E. J. Bazzo, MD, FAAFP Immediate Past President: J. Steven Poceta, MD



What Do Presidential Elections, the Legislative Process, and “Who Shot JR?” Have in Common?



departments 4

2015 SDcms Annual Report

Briefly Noted: Calendar • PDA Hotline • History Thumbnails • SDCMS Staff Update • And More …

6 Leadership Series: John E. Jenrette, MD

AT-LARGE and AT-LARGE ALTERNATE DIRECTORS Lase A. Ajayi, MD • Karrar H. Ali DO, MPH • Steven L-W. Chen, MD, FACS, MBA (Alt.) • Stephen R. Hayden, MD • Phil Kumar, MD (Alt.) • Vimal I. Nanavati, MD, FACC, FSCAI (Alt.) • Robert E. Peters, MD, PhD (Alt.) (Delegation Chair) • Carl A. Powell, DO (Alt.) • Peter O. Raudaskoski, MD • Kosala Samarasinghe, MD • Thomas J. Savides, MD • James H. Schultz Jr., MD, MBA, FAAFP (Board Rep) • Karl E. Steinberg, MD, FAAFP (Alt.) • Erin L. Whitaker, MD (Alt.) • Marci M. Wilson, MD (Alt.) • Holly B. Yang, MD (Board Rep) OTHER VOTING MEMBERS Communications Chair: Sherry L. Franklin, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Michael C. Hann, MD Retired Physician Director: Rosemarie M. Johnson, MD Medical Student Director: Sandeep Prabhu



OTHER NONVOTING MEMBERS Young Physician Alternate Director: Heidi M. Meyer, MD Resident Physician Alternate Director: Quinn C. Meisinger, MD Retired Physician Alternate Director: Mitsuo Tomita, MD SDCMS Foundation President: Albert Ray, MD (At-large AMA Delegate) CMA Speaker: Theodore M. Mazer, MD (At-large AMA Alternate Delegate) CMA Past Presidents: James T. Hay, MD (AMA Delegate) • Robert E. Hertzka, MD (Legislative Committee Chair, At-large AMA Delegate) • Ralph R. Ocampo, MD, FACS CMA Trustee: Bob E. Wailes, MD AMA Alternate Delegate: Lisa S. Miller, MD

Heed Those EHR Alerts BY JACQUELINE ROSS, PHD, RN, and Susan Shepard, MSN, RN

GEOGRAPHIC and GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD (Alt.) • Jay P. Mongiardo, MD • Alexandra E. Page, MD • Venu Prabaker, MD Hillcrest: Gregory M. Balourdas, MD • Kyle P. Edmonds, MD (Alt.) • Thomas C. Lian, MD Kearny Mesa: Sergio R. Flores, MD • John G. Lane, MD • Anthony E. Magit, MD (Alt.) • Eileen R. Quintela, MD (Alt.) La Jolla: Geva E. Mannor, MD, MPH • Marc M. Sedwitz, MD, FACS • Wayne C. Sun, MD (Alt.) North County: Neelima V. Chu, MD (Alt.) • Michael A. Lobatz, MD • Eileen S. Natuzzi, MD • Patrick A. Tellez, MD South Bay: Elizabeth Lozada-Pastorio, MD (Alt.) • Reno D. Tiangco, MD • Michael H. Verdolin, MD



ractice Management P Tip of the Month Y THE CALIFORNIA MEDICAL B ASSOCIATION


2015 SDCMS Annual Report


Physician Marketplace: Classifieds


POLST E-Registry San Diego & Imperial Counties: SBAR



May 2016

28 Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to All advertising inquiries can be sent to San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

“When we found we could refinance our student loans with our First Republic personal banker, we jumped at the chance.” CHRISTINA PHAM, M.D.

J O H A N N E S K R AT Z , M . D .

UCSF Medical Center

UCSF Medical Center

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/////////Briefly /////////////////Noted //////////////////////////////////////////////////////////////////////// calendar


National Advice Line for Providers

SDCMS-CMA Webinars & Events

For further information or to register for the following, contact Jen at (858) 300-2781 or at JOhmstede@ Reimbursement 101: Getting Paid (webinar) MAY 18: 12:15–1:15pm

Community Healthcare Calendar To submit a community healthcare event for possible publication, email KLewis@SDCMS. org. Events should be physician-focused and should take place in or near San Diego County.

CHPI Physician Quality Rating Program: Navigating the Review and Corrections Process (webinar) MAY 25: 12:15–1:15pm

Asthma Educator Institute (hosted by the American Lung Association) MAY 16–17 at the California Endowment in Downtown Oakland

2016 SDCMS White Coat Gala: Celebrating 146 Years of Healing (event) JUN 4: 6:00pm– 11:00pm at the Hyatt Regency La Jolla at Aventine

Clinical Management for Diabetes Care: New Approaches for the Real-World Practice MAY 20–21 at the Estancia La Jolla Hotel and Spa

How to Increase Workers’ Compensation Revenue (webinar) JUN 8: 12:15–1:15pm

Asthma Educator Institute (hosted by the American Lung Association) MAY 26–27 at the Torrance Memorial Hospital

DMHC IMR and Other Complaint Processes: Tips and Best Practices for Physicians (webinar) June 22: 12:15–1:15pm Physician Networking Opportunity & Mixer (social) AUG 5: 5–8pm at 57 Degrees in Mission Hills


May 2016

San Diego Psychiatric Society’s 57th Annual Installation and 2-day Conference JUN 3 (Installation) & 4–5 (Conference) at the Marriott La Jolla. The installation will include a dinner, entertainment, and great company.

The conference — Integrating Mental and Physical Health — is an accredited CME/CEU event for physicians, nurse practitioners, psychologists, social workers, marriage and family therapists, and other mental health professionals, and will include experts from around the country and state. For complete details, visit www. From Conversations to Action: Palliative Care Across the Continuum JUN 10 at California State University, San Marcos, USU Ballroom Red Shoe Day to Support Family Care at San Diego’s Ronald McDonald House JUN 23 Across San Diego County SDAFP Annual Family Medicine Update JUN 24–26 at Paradise Point Hotel in Mission Bay Superficial Anatomy and Cutaneous Surgery JUL 9–17 at the San Diego Marriott Del Mar

The Clinical Consultation Center (CCC) is a national advice line for providers. It is open Monday through Friday, 7 a.m. to 3 p.m., and is managed by the UCSF physicians that do the HIV advice line. The San Diego Prescription Drug Abuse Medical Task Force tested out the system with a case presentation. Dr. Joanna Evelyn, medical director, answered the phone and was able to give feedback on the case. The physicians answering the phone are certified in primary care and addiction treatment and encourage any provider to call for confidential clinical advice on patients with substance use disorders. Call (855) 300-3595.

/////////////////////////////////////////////////////////////////////////////////////////////////// History Thumbnails

Anita Figueredo, MD* By Sarita Eastman, MD Dr. Anita Figueredo arrived in San Diego in 1947 as the city’s first woman surgeon, with an improbable backstory. Born in 1916 in Costa Rica — a country which, in the early 20th century, had neither a medical school nor a tradition of higher education for women — Anita decided to become a doctor and, in 1921, sailed into New York harbor with her formidable young mother who supported them both as a seamstress until the day of her daughter’s graduation from Long Island College of Medicine in 1940. That summer of 1940, Anita began a rotating internship at New York Infirmary for Women and Children and continued on the next year in surgery-gynecology — until the United States was abruptly plunged into WWII and the male surgical residents called away to war. In July 1942, Anita became one of the first two women residents at New York’s Memorial Hospital for Cancer. A month later she married medical school classmate, pediatrician, and Naval Lieutenant Dr. William Doyle, just before he steamed away to the South Pacific. It was Bill Doyle, during wartime visits to Balboa Naval Hospital, who discovered San Diego. In 1948, Anita joined surgical oncologist Dr. Frank Hankins as his assistant in a gratifying practice that took them to five hospitals: Paradise Valley, Mercy, County, Scripps, and Quintard. But, by the end of 1949, Anita was pregnant with the fifth of her nine children and realized she had to limit her travel to La Jolla and Scripps. Although Anita’s training in surgical oncology had been general, there was added

emphasis on certain regions: skin, head and neck, breast and pelvis — and these became the focus of a private practice that grew exponentially until she retired from major surgery after 30 years because of a disabling illness. She eventually returned to office practice in minor surgery and the follow-up of her large cohort of cancer survivors until her final retirement at the age of 80. Anita Figueredo, surgeon and mother of nine, with a deeply committed partner and household help, was an expert in time management and active in community, church, and philanthropic affairs, including her own foundation: Friends of the Poor. Anita had a deep friendship with Mother Teresa of Calcutta from their first meeting in San Diego in 1960, which led to the establishment of Mother Teresa’s nuns in Tijuana in 1988. After 57 years of marriage, Anita lost her devoted husband, Bill Doyle, in 2000. She herself died at home on Feb. 19, 2010, age 93, surrounded by her family. Two years later the home and adjacent medical office at 417 Coast Blvd. / 418 S. Coast, La Jolla, were together designated “The Dr. Anita Figueredo Buildings” as a permanent historical resource for San Diego *Editor’s Note: Drs. Figueredo and Doyle are the parents of Sarita Eastman, MD. She is married to Brent Eastman, MD, a past president of the American College of Surgeons. Dr. Sarita Eastman practiced pediatrics for many years in La Jolla. All have been longstanding members of the San Diego County Medical Society.

Earth laughs in flowers.

— Ralph Waldo Emerson, Essayist, Lecturer, and Poet Who Led the Transcendentalist Movement of the Mid-19th Century (1803–1882)

Sue With Her Husband, Dean, at SDCMS’s April 26 Physician Social


Welcome Sue Fledderjohn! Sue joins SDCMS from UC San Diego School of Medicine. Sue was the events coordinator in the Office of Student Affairs, overseeing orientation week, Match Day, and commencement. She has worked with hundreds of medical students as advisor for student interest groups and organizations: The Human Condition magazine, dedicated to prose, poetry, artwork, and photography by medical students and faculty; student council government; and health and wellness programs. Sue, executive assistant to Paul Hegyi, can be reached at (858) 300-2786 (desk) or via email at Sue.Fledderjohn@ SAN DIEGO


L e a d e r s h i p — 4th i n a S e r i e s

Dr. Jenrette — 12-year member of SDCMS-CMA — is board certified in family medicine and geriatric medicine, and CEO of Sharp Community Medical Group (SCMG), a network that includes more than 200 primary care physicians and 600 specialists, and provides care to more than 155,000 members through eight health plan HMO and ACO contracts.

John E. Jenrette MD, CEO, Sharp Community Medical Group (SCMG)

John E. Jenrette MD, CEO, Sharp Community Medical Group (SCMG) by Sherry Nooravi, PsyD

The following interview is part four of an eight-part leadership series, with interviews conducted by organizational psychologist Dr. Sherry Nooravi. See the January issue for an interview with Dr. Paul Bernstein, medical director and chief of staff at Kaiser Permanente San Diego, the February issue for an interview with Dr. Wendy Buchi, CEO of IGO Medical Group, and the March issue for an interview with Dr. Steven Green, CMO of Sharp Rees-Stealy Medical Group. Dr. John Jenrette can be reached at (858) 499-4540 or at john.jenrette@


May 2016

Question: What is your leadership philosophy? Answer: Leadership is all about collaboration. The leader is the coach and the driver of that effort. I’m a collaborator because you can do so much more in an organization when you work together. It is also about integrity — it is in the words that you say, how you treat people, your promises and your follow-up. If you lose integrity, you lose the game. As a leader it is important to bring people along to understand the journey, how you make a decision and how you got there. If you start at the end and people have not been part of the journey, you lose them. It’s about vision and inspiring people on that journey. A good leader also needs to guide his or her team toward effective execution and overall accountability. Otherwise, the “plane never lands” and the organization stays at 30,000 feet. I find it hard to work with leaders who are full of themselves and autocratic. They send a message that says, “It’s my way, my decision, and I don’t respect others’ opinions.” People really tend to disengage from that type of leader. Question: What should physicians do to prepare for the future of healthcare? Answer: Ideally, physicians need to push themselves outside of their comfort zone that, usually and appropriately, centers around the clinical practice of medicine. Our clinical training and seeing the patient is ingrained in us. We focus on the diagnosis and the treatment plan as any good physician would. The key here is to get involved, become educated about what is going on in healthcare, and, in general, broaden your horizon and scope of knowledge outside of your clinical practice. In doing so, one usually will be more open to and react more favorably to change or challenges.

The future also predicts that medicine is no longer a solo sport. It is a team sport, and you eventually need to be a part of something bigger. Currently, and even more so in the future, there is far too much to know about the business of medicine, the evolving political landscape (including regulatory and compliance requirements), and the changing methods of reimbursement. It is virtually impossible for any one physician or office to understand or succeed on his or her own. Question: What advice do you have for young/incoming physician leaders? Answer: Over the past 10 years, I’ve seen young physicians rejecting the 80-hour physician workweek in favor of a balance in clinical time and lifestyle. Recently, however, I’m seeing a resurgence in young physicians’ interests and openness to new ideas and changes. They are in the big technology world, and they are really excited about what’s new and different, and the challenges, technology, and politics of medicine. For these physicians it is again about getting involved, putting oneself out there, and becoming educated about the world beyond clinical practice. Question: What does organizational culture mean to you and how do you drive it? Answer: It is all about the people and not about me, as the leader. As a leader you try to mold the culture to produce the kind of outcomes and environment you are seeking to create. It goes back to my leadership philosophy about integrity, collaboration, and inspiring people toward the journey you want to take. In creating a successful culture, it is also important to be humble and to have a sense of humor as a part of that culture. Real success is accomplished through the empowerment of your people. Many leaders fall short by micromanaging and restricting people’s growth and initiative. If I were hiring a tennis coach, I’d want feedback. In leadership, it’s also about feedback. When we get into business, people are afraid to give feedback and they also don’t usually like to receive it. It’s hard for people to get a mid-course correction, and they sometimes feel like they are a bad person because of it. Culture change also requires time and effort. I once worked with a medical group during a time of growth in its history when we were combining the cultures of two different medical practices, a kind of melding of the cultures. To accomplish this, we constantly went back to the common vision, the greater good, and gave permission to think

“Real success is accomplished through the empowerment of your people. Many leaders fall short by micromanaging and restricting peoples’ growth and initiative. If I were hiring a tennis coach, I’d want feedback. In leadership, it’s also about feedback. When we get into business, people are afraid to give feedback and they also don’t usually like to receive it.” and speak differently at the table together. It definitely takes time, effort, relationship building, and a healthy dose of collaboration to change a culture. If you try to change culture by issuing marching orders, you may feel successful in the short term, but I guarantee when you revisit it, this perceived cultural change will be undermined and not a reality. Question: What has worked for engaging your staff that CEOs and leaders in other industries can learn from? Answer: Create wins and reward and recognize those efforts that you want to perpetuate in the organization. It is easy and it is contagious. You also have to constantly seek input from others. Yes, listen. A good physician listens in an exceptional manner with patients. Listening is so powerful and it works in all settings. Dr. Nooravi is an organizational psychologist and CEO of Strategy Meets Performance, a leadership consulting firm that focuses on helping CEOs of fastgrowth companies shape engaging, innovative, and customer-driven cultures through executive coaching and senior team facilitation. She has been named “Trailblazer of the Year” for her research on the best practices of CEOs of high performing organizations. She can be reached at sherry@ or at (312) 286-0325.

Points to Consider


Share the Journey: When you make changes, do you bring the team along, share the vision, and inspire them, or do you mandate change?


What’s Going on in Healthcare? Are you clear about upcoming changes in healthcare, and are you collaborating with other physicians and staff members to drive positive change in your system?


Let It Go: Are you empowering your people and coaching them — versus micromanaging or completely letting go and not helping?



R i s k M a n ag e m e n t

Heed Those EHR Alerts By Jacqueline Ross, PhD, RN, and Susan Shepard, MSN, RN

Patient harm caused at least in part by the use of electronic health records (EHRs) — or e-iatrogenesis — emerged as a factor in a closed claims study conducted by The Doctors Company. The study of 71 claims closed by The Doctors Company between 2007 and 2013 revealed that 65% involved EHR-related user issues, and 42% identified system technology design risk factors. Some claims included both user


may 2016

issues and system technology design risk factors. The ECRI Institute (formerly Emergency Care Research Institute) recognized alarm hazards as the number-one IT-related problem in 2015. Alarm hazards occur not only with physiologic monitoring systems (1), but also with alarm-generating devices, such as EHRs. Unfortunately, human factors may prevent healthcare providers from respond-

ing appropriately or using the alarms that are readily available to them. EHRs have multiple benefits — from improved patient outcomes and improved care coordination to practice efficiency and cost savings. However, inappropriate use of or ignoring EHR alarms/alerts has been connected to patient harm. On the issue of over-alerting (systems generating too many alerts), Dr. Tejal K. Gandhi, president and CEO of the National Patient Safety Foundation, noted “most studies have found that only 20% of alerts are actually accepted,” so an important alert could be missed. She added that studies have shown that reducing the number of alerts “by streamlining the ones that you decide to alert on, by tiering, to only interrupt for things that have a certain amount of significance, you can actually reduce the number of interruptions significantly” (2). E-health data come from external sources, such as websites, or through health information exchanges (hospital charts, consultant reports, and laboratory and radiology reports). Doctors also have access to data through e-prescribing community medication histories, which can expose them to liability for potential interactions with drugs prescribed by other clinicians. For example: Dr. A renews a medication, and his e-prescribing program sends an alert advising him that the medication could interact with another medication the patient is taking. He has not prescribed that drug, so his office staff will have to contact the patient to identify who has prescribed it, and then Dr. A will have to contact Dr. X to “negotiate” which drug will be discontinued or changed. If failure to take action results in patient injury from a drug-drug interaction, Dr. A may be liable (3). Drug-drug interaction lists are often so comprehensive and generate alerts with such frequency that they can become disruptive and annoying. Doctors may develop “alert fatigue” and ignore, override, or disable them. However, if it can be shown that following an alert would have prevented an adverse patient event, the physician may be found liable for failing to respond (4). Optimized, clinically meaningful drug-drug interaction lists that focus on a smaller set of interactions most frequently associated with harm or expert consensus lists may address this problem. However, EHR vendors may resist eliminating the low-risk warnings, fearing that doing so could increase their liability. The following two claims illustrate some of the issues surrounding alerts and human factors.

Claim One An elderly female saw an otolaryngologist for ear/nose complaints. The physician intended to order Flonase nasal spray. The patient filled the prescription and took it as directed. Ten days later, she went to the ER for dizziness. Two weeks after that, the pharmacy sent a refill to the physician at his request. It was for Flomax — a medication prescribed for enlarged prostate — which has a side effect of hypotension. When ordering the prescription, the physician had typed “FLO” in the medication order screen. The EHR automatched Flomax, and the physician selected it without realizing the mistake. Flomax is not FDA-approved for females. There was no EHR Drug Alert available for gender. To prevent this type of mistake, the provider should have reviewed the prescription with the patient and read what was ordered. By writing the indication for the medication on the prescription, the pharmacist would have been alerted that the medication was not appropriate to the condition being treated.

Claim Two A dialysis patient was transferred to a skilled nursing facility. There was an active hospital transfer order for Lovenox. A physician evaluated the patient on admission but made no comment about the Lovenox order. During the first dialysis treatment, there was active bleeding at the fistula site. The anticoagulant heparin had not been given. The nursing staff did not inform the physician of the bleeding. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient exsanguinated and expired. Experts were critical that there was no EHR high-risk medication alert. Medication reconciliation might have prevented this error. Strategies for Reducing Alert Hazards • Understand alarm fatigue. When caregivers become overwhelmed, distracted, or desensitized to an alarm or an alert, determine the most important alarms, and work with your vendor to ensure that unnecessary alarms or

alerts are not built into your system (5). • Determine if alerts are appropriately configured so that alert conditions are not missed or ignored (6). • Assess your EHR for frequent drugdrug interaction alerts, which have been shown to lead to alert fatigue that can cause the alerts to be disregarded, ignored, or disabled. Work with your EHR vendor to use key data elements to design EHR alerts for high-risk drugto-drug interactions. The result will be more meaningful alerts that are less likely to be ignored or disabled, thus avoiding a possible error. • Be aware that clicking through drugto-drug therapeutic duplicates or drug/ allergy alerts with little review can be interpreted to mean that the physician ignored the safety alerts. • Read the alerts. EHRs record how much time is spent reviewing information. If the time is very brief and there is a negative patient outcome, the physician could be perceived as sloppy or hurried.

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R i s k M a n ag e m e n t

• Don’t turn off alerts. If a hospital-employed physician and hospital turn off alerts that could have avoided a patient problem, the hospital and physician may both be found liable. • Always document why a clinical decision support (CDS) prompt was overridden. CDS may conflict with a medical specialty’s clinical standards of care or practice guidelines or with the information in FDA-approved drug labels (7). Alerts are a necessary safety mechanism when used, heeded, and configured appropriately for your practice. Check your alerts to make sure they provide adequate information and are not overly burdensome to your practice. References 1. ECRI Institute. Top 10 Health Technology Hazards for 2015: A Report From Health Devices. November 2014. www. Accessed July 1, 2015. 2. Texas Medical Institute of Technology.

Webinar Transcript: Ambulatory Patient Safety Issues — Opportunities for Improvement. downloads/WebinarTranscript_August2013.pdf. Aug. 15, 2013. 3. Troxel D. Electronic Health Record Malpractice Risks. The Doctors Company. Available at: KnowledgeCenter/PatientSafety/articles/Electronic-Health-Record-Malpractice-Risks. Accessed July 1, 2015. 4. Ibid. 5. Lacker C. Physiologic Alarm Management. Pennsylvania Patient Safety Advisory. 2011 Sep;8(3)105-8. 6. ECRI Institute. Top 10 Health Technology Hazards for 2015: A Report From Health Devices. November 2014. www.ecri. org/2015hazards. Accessed July 1, 2015. 7. Russ AL, Zillich AJ, McManus MS, Doebbeling BN, Saleem JJ. Prescribers’ interactions with medication alerts at the point of prescribing: a multi-method, in situ investigation of the humancomputer interaction. Int J Med Inform. 2012 Apr;81(4):232-243.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Ms. Ross is senior clinical analyst, Department of Patient Safety and Risk Management, and Ms. Shepard is director, Patient Safety and Risk Management Education, for SDCMS-endorsed The Doctors Company. For more patient safety articles and practice tips, visit www.

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The Misspent Healthcare Dollar: The Misspent Healthcare Dollar: Why, When, and How Why, When, and How

June 16 –19, 2016 Manchester Grand Hyatt Panel: Healthcare Reform San Diego Panel: Healthcare Reform Forecast Forecast Susan Dentzer

Susan Dentzer Stephen Shortell, PhD, MPH, MBA Stephen Shortell, PhD, MPH, MBA Mark Smith, MD, MBA Mark Smith, MD, MBA

Moderated by Donald H. Crane, President Moderated by Donald H. Crane, President and CEO, CAPG and CEO, CAPG

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Featured sessions:Laughter is Good for Your Health

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May 2016


hances are, no matter your generation, you know “Who shot JR?” — the question at least, if not the actual perpetrator. But why? Why has a plot point from a 1980s prime-time soap opera stuck in our cultural imagination so tenaciously? And what, pray tell, does any of that have to do with presidential elections or the legislative process? “A House Divided” — the Dallas episode and season-three finale that left America wondering throughout the summer and fall of 1980 which of JR’s enemies shot him and whether, in fact, he had survived — was broadcast on March 21, 1980. We didn’t find out who did it until the “Who Done It?” episode aired the following November. Interestingly, that March to November stretch coincided quite nicely with the 1980 presidential race, itself a suspense-filled run full of cliffhangers and gotchas that aroused (people forget) no less excitement and triggered just as much anxiety as this year’s fun-filled race for the White House. Funny side note: During the summer of 1980, Republicans distributed “A Democrat shot JR” campaign buttons. In case you’re not a buff of American history or just plain don’t remember, there were three major Democratic candidates for president in early 1980: incumbent Jimmy Carter, Senator Ted Kennedy of Massachusetts, and our very own Governor Jerry Brown (first iteration). After Brown withdrew from the race on April 2, Carter and Kennedy faced off in caucuses and primaries throughout the spring and summer, until finally, at the August 11–14 national convention in New York City,

Carter was nominated … but only after Kennedy tried to pull some shenanigans at the convention. Incumbent President Jimmy Carter went to the Democratic National Convention at Madison Square Garden on August 11, 1980, with 60 percent of the delegates pledging their first-ballot fealty — enough to secure the nomination. Nevertheless, Senator Kennedy refused to acquiesce and tried to change the rules to release delegates from their first-ballot pledges. In the end, on the first ballot, Carter received the nomination with 2,129 votes to Kennedy’s 1,146 — but, alas, for naught, as Carter lost the presidency in November when Reagan received 489 electoral college votes to his 49, the worst walloping by an incumbent president since Taft won only eight electoral votes in 1912. Side note: In the 1912 presidential race, Theodore Roosevelt ran as a third-party candidate, dooming the Republican incumbent Taft’s chances. Makes you wonder, is there really anything new under the sun? Does what goes around always come around? Are those who cannot remember the past condemned to repeat it? And just what does any of this — JR and presidential elections — have to do with the legislative process??

“I didn’t realize how important the physician voice is in policymaking until meeting personally with legislators from our district. We could take the theory and guesswork out of policymaking by explaining concretely how the bills we were lobbying would impact not only us as physicians but our patients as well. Without this perspective, you have people making big decisions that will impact doctors and patients alike without the input of the people who know this work best.” — Cecilia Bonaduce, MS-1, UC San Diego School of Medicine



• • • •

(L–R) Dr. Mihir Parikh, Paul Hegyi, Dr. William Tseng, Dr. Robert Wailes, Asemblymember Marie Waldron, Dr. Albert Ray, Dr. Mark Sornson, Nicholas Cardillo, Cecilia Bonaduce, Dr. Bing Pao, Abhishek Kumar, and David Li outside the Capitol during CMA’s Leg Day this past April 13.

* * *


DCMS and CMA member physicians spend countless hours — gratis — away from their practices and patients making legislators aware of how proposed legislation might enhance or threaten your patients’ health and your ability to practice medicine. To wit, SDCMS and CMA physicians work indefatigably to influence the introduction of legislation, shape the language and impact of legislation, educate legislators, staff, and stakeholders, influence how legislators vote on legislation, and build positive relationships with legislators to gain their trust. Each year, SDCMS and CMA take public positions on more than 200 bills — watch, support, oppose, support if amended, or oppose if amended — and monitor those bills as they move through the long legislative process:

“CMA greatly helps me to be informed and up to date in regard to healthcare policy and what the future practice of medicine will be.” — Nicholas Cardillo, MS-1, UC San Diego School of Medicine


May 2016

“It was truly inspiring to see all these physicians taking the time out of their busy practices to make the trip to strengthen relationships with our state legislators. Their efforts really showed in the reception that we received: Physicians had built strong personal relationships with legislators, and the legislators in turn trusted physicians as experts and partners in healthcare policy.” — David R. Li, MS-1, UC San Diego School of Medicine

bills are introduced there are committee hearings floor action is taken if a bill is passed, it’s sent to the other house • more committee hearings • more floor action • if the bill is passed with amendments, it’s returned to its original house • if the bill’s original house concurs, the bill goes to the governor • if the governor signs it, the bill usually becomes law the following year Throughout this tedious yet vital process, while your SDCMS and CMA physician leaders are tirelessly lobbying on your behalf, government agencies, health plans, health insurers, labor unions, hospitals, clinics, trial lawyers, consumers, pharmaceutical companies, purchasers, employers, businesses, and myriad others are lobbying on behalf of their own constituents. Have you ever spent any time in Sacramento or Washington, DC? You can be sure that if you’re not at the table, you’re on the menu. This past April 13, CMA hosted its 42 nd Legislative Advocacy Day in Sacramento. This annual event is a unique opportunity for more than 400 CMA-member physicians and medical students from across California to convene on Sacramento to lobby their legislative leaders as champions for medicine and for patients. Paul Hegyi, SDCMS’s CEO, joined 10 SDCMS physicians and medical students — Drs. Bing Pao, Mihir Parikh, Albert Ray, Mark Sornson, William Tseng, and Robert Wailes, and medical students Cecilia Bonaduce, Nicholas Cardillo, Abhishek Kumar, and David Li — for the event, spending the day meeting with Senators Joel Anderson and Ben Hueso, Assembly Speaker Emeritus Toni Atkins, and Assemblymembers Rocky Chávez, Lorena Gonzalez, Brian Jones, Brian Maienschein, Marie Waldron, and Shirley Weber. Three bills currently before the Legislature were discussed, the first supported by CMA, the second sponsored by CMA, and the third opposed by CMA: 1. SB 22 (Roth): Expanded Primary Care Physician Training 2. AB 2121 (Gonzalez): Responsible Beverage Service Training 3. AB 533 (Bonta): Out-of Network Billing SB 22, supported by CMA, will increase funding for the Song-Brown Health Care Workforce Training Program — which expires this year — by $100 million per year through a state budget appropriation

“It’s critical for us as medical students to learn not only clinical skills, but also to understand and appreciate the complexities our future patients are experiencing in the ever-changing healthcare landscape.”

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— Abhishek Kumar, MS-1, UC San Diego School of Medicine

and create a robust and consistent funding source to stem the loss of primary care physicians in California. AB 2121, sponsored by CMA, seeks to help reduce alcohol service to already intoxicated individuals and to reduce drunk driving by requiring establishments that serve alcohol to customers to employ servers and managers who have received responsible beverage service training. AB 533, opposed by CMA, requires health plan contracts and insurance policies to provide that patients only owe in-network cost sharing when they receive care from an out-of-network provider at an in-network facility. AB 533 also requires this cost sharing to count toward annual deductibles and out-ofpocket limits, just like cost sharing for in-network services. Leg Day meetings with legislators last 10 to 15 minutes each, tops: two minutes up front to check in on the spouse and kids, four minutes each for the three bills on the table, and one minute at the end to wrap up and take pictures. What goes into these meetings? The physicians have learned, by taking SDCMS training workshops, to state their cases concisely, to stay focused, and to tell personal stories. They’ve done research on the legislators (“Which term are they in?” “What’s their district like?” “What are their re-election issues?” “Where are they most likely to stand on the issues?” “What committees and subcommittees do they sit on?” Etc. You get the point.). The physicians have to be prepared and flexible, and, in the end,

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May 2016

strong enough to ask for a commitment yet genial enough to ensure the legislator wants to keep in touch. Legislators, for their part, are wondering about the bills, “Is this good public policy?” “How does this affect my district?” “Will it help or hurt me politically?” “Does anyone back home know or care about this issue?” and “Who supports it and who opposes it?” Again, you get the point. So what, for the third time, do JR and presidential elections have to do with the legislative process???


* * *

he answer: Little, if anything — my apologies for the letdown. You see, cliffhangers, red herrings, MacGuffins, magical objects, and other plot devices work well when we’re sitting back in our living rooms enjoying our favorite TV shows or binge-watching endless presidential debates, town-halls, primary elections, and caucuses. But the legislative process that matters to you, that directly affects your patients, your families, and your communities today and every day, the process that endlessly churns through hundreds of bills year in and year out, that necessitates thousands of meetings, tens of thousands, hundreds of thousands, sometimes millions of dollars, does not make for good entertainment. There’s little if any suspense, the game is long and resource intensive, and it requires every single physician to give of his or her time, talent, or treasure. Not an easy sell. To pound this into a bloody pulp: I repeat, SDCMS and CMA are not alone in Sacramento meeting with legislators. Government agencies are there. Health plans and health insurers are there. Labor unions and trial lawyers are there. Hospitals and clinics. Pharmaceutical companies. The list goes on and on. Ensuring your voice and your patients’ voice is heard in the din of all this is the job of your San Diego County Medical Society and your California Medical Association. But we can’t do it without you. If you’re already a member, thank you. If you’re not an SDCMS-CMA member (and just because you get this magazine doesn’t mean you’re a member), please reconsider — again, we can’t do it without you. Oh, and in case you were wondering, Kristin Shepard — JR’s sister-in-law and mistress — shot him. JR didn’t press charges against her, though, because she was — GASP! — pregnant with his child. But even that wasn’t the end of the story: Turns out, the child …

TrusT “I think I am most impressed by how well the San Diego legislators understand healthcare legislation and the impact it may have on patients, physicians, and other interested healthcare parties. The legislators really appreciate the physician perspective, and it seems to have a profound impact on their final decision when they debate the bill in committee and make the final vote. For example, when we met with Assemblyman Brian Jones, we actually challenged a bill he was authoring, offering an argument that he had not heard. It was great to see him open to hearing other viewpoints and possibly adjusting his position on his own bill.”

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— Mihir Y. Parikh, MD, Presidentelect, SDCMS Endorsed by

Kyle Lewis is the director of communications and marketing for SDCMS. SAN DIEGO






Make sure your practice isn’t penalized under the new provider directory accuracy law. The new law (SB 137) not only requires payors to maintain accurate and current directories, but it also requires physicians to do their part in keeping the information up-to-date. Failure of practices to comply with the new requirements may result in payment delays, removal from directories and even contract termination. For more information, watch CMA’s on-demand webinar on SB 137 at

The webinar will provide an overview of SB 137 and a pilot program, launched by America’s Health Insurance Plans, to ensure provider directories comply with the new law, while reducing the administrative burden for physician practices.

CMA’s robust webinar series gives you the opportunity to watch live presentations on important topics to help you run a successful medical WEBINARS • SEMINARS • PODCASTS • AND MORE out the current schedule at practice. Webinars are free to members and their staff. Check DID YOU KNOW?

TROUBLE GETTING PAID? WE CAN HELP! CMA’s Center for Economic Services is staffed by a team of practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Access to our reimbursement experts is a FREE, members-only benefit. Call (800) 786-4262 or email

Meet Your Advocate: Kris Marck

Kris is Associate Director in CMA’s Center for Economic Services. Before joining CMA in 2011, she spent 23 years working on the payor side of the health care industry. This previous experience makes her a very effective and approachable advocate for physicians in need of reimbursement and contracting assistance.

Working with payors is challenging and the reimbursement process is complex. Don’t hesitate to call us. It’s easy to give the easy answer, but it’s difficult to go and find the right answer. We’ll get you the right answer.” Kris Marck, Associate Director, CMA Center for Economic Services TO OPT OUT OF FUTURE NOTICES, EMAIL MEMBERSERVICE@CMANET.ORG OR FAX (916) 551-2036. BE SURE TO INCLUDE THE FAX NUMBER YOU WANT REMOVED.


May 2016


2015 SDcms Annual Report

A 21% cut to physicians’ Medicare payments was set to take place on April 15, 2015. Instead, HR 2 — the monumental, bipartisan Medicare SGR Payment Reform and CHIP Reauthorization Act — was passed by the House of Representatives 392–37, by the Senate 92–8, and signed by the president, providing positive annual payment updates of 0.5% starting July 2015 and lasting through 2019. SDCMS and CMA extend a sincere thank you to all member physicians for the extraordinary campaign this last decade to end the SGR, holding Congress’s feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, Senators Feinstein and Boxer and 52 out of 54 members of the California congressional delegation voted to support physicians — a direct result of long-term SDCMS and CMA advocacy. Many will claim credit, but let there be no doubt that SDCMS-CMA member physician dues dollars made this happen. Combine this huge SGR win with the victories on Proposition 46, GPCI, arresting the Medi-Cal cuts for three years, preventing any Medi-Cal clawbacks, stopping scope of practice expansions — the list could go on — and the message could not be any clearer: Nonmember physicians have received significant value from member dues dollars; please join your fellow physicians who have contributed to these successes by becoming an SDCMS-CMA member today!



2015 SDcms Annual Report

 LEGISLATIVE ADVOCACY SDCMS’s Legislative Advocacy Trips in 2015: • On April 14, 2015, eight SDCMS physicians joined more than 400 others from across California for CMA’s 41st annual Legislative Advocacy Day in Sacramento to speak with legislators and their senior staff about healthcare issues that affect their practices and the future of medicine. • SDCMS took two groups of medical students to Sacramento in 2015 to meet with legislators, and joined the San Diego Regional Chamber of Commerce during its legislative trip to Washington, DC. CMA Sponsored Legislation in 2015 to … • Increase California’s tobacco tax and allocate those funds to tobacco prevention and education. • Provide oversight for allocation of funds raised for Medi-Cal use. • Repeal cuts to Medi-Cal provider reimbursement rates. • Allow NPs and PAs, under physician supervision, to sign POLST forms. • Require healthcare service plans to honor assignment of benefit agreements. • Close a loophole allowing health insurers to choose the regulator with which to file their PPO products. • Enable grants to residency programs in areas with the greatest need. • Require health insurers to pay providers for telephone and telehealth services. • Require employers and insurers to disclose payment methodologies for those involved in providing medical services to injured workers. • Provide treating physicians fair payment.


MAY 2016

SDCMS Physicians and Staff at CMA’s House of Delegates in Anaheim

STOPPING UNSAFE SCOPE EXPANSIONS Thanks principally to CMA advocacy, Senator Hernandez pulled both his scope expansion bills, which would have allowed NPs to practice independently and given optometrists the ability to do ophthalmologic surgery.

PROTECTING MICRA A California court ruled against a constitutional attack on MICRA thanks in large part to an amicus brief filed by CMA.

CAL MEDICONNECT SDCMS actively participates in the Coordinated Care Initiative Advisory Committee to improve the delivery of healthcare and long-term services and supports to San Diego County seniors and persons with disabilities. In 2015, SDCMS continued to help members, their offices, and their patients navigate Cal MediConnect, along with CMA, whose valuable “Cal MediConnect Physician FAQ” resource teaches physicians what they need to know to keep their patients and to bill for the dual-eligible population.

CURES PROTECTING THE PUBLIC HEALTH • CMA Leads Save Lives California Coalition Initiative to Raise State’s Tobacco Tax by $2 per Pack • Governor Brown signed CMA-sponsored legislation to make California one of three states not to offer a personal belief or religious exemption for required vaccinations — a perfect example of CMA’s using its influence to impact public health.

• CMA convinced the DOJ to delay the final rollout of CURES 2.0 by six months due to browser requirement concerns that could have cut off access for thousands of prescribers and dispensers. • In the final days of the 2015 legislative session, after the DOJ still had not identified and implemented a streamlined CURES application and approval process, CMA secured the extension of the registration deadline to July 1, 2016.

MEDI-CAL • In June The San Diego Union-Tribune published “Medi-Cal Boom Brings Capacity Questions,” with SDCMS communications director, Sherry Franklin, MD, interviewed. • CMA closely monitored DHCS’s temporary conversion of incoming ICD-10-coded claims to ICD-9 for problems. • SDCMS’s Dr. Ted Mazer was interviewed for PBS’s “Giving Millions More Access to Care, Medicaid Expansion Strains California’s Health System” Report. • CMA pushed for a permanent and significant Medi-Cal funding increase at the Legislature’s special session on Medi-Cal financing. • CMA joined the Save Lives California coalition to raise the state’s tobacco tax and improve public health, with money generated directed to Medi-Cal and to smoking prevention, cures, and strengthening a healthcare system strained by tobacco-related disease. • A broad CMA-led coalition rallied thousands at the state capitol on June 2 to support fully funding Medi-Cal. • CMA sponsored bills to increase Medi-Cal rates. • CMA submitted a letter to CMS requesting an assessment of MediCal rates. • A CMA-led coalition introduced legislation to increase Medi-Cal rates to Medicare levels.

HOSPITAL MEDICAL STAFFS • SDCMS attended 24 hospital general staff and medical executive committee meetings in 2015 with updates on physician issues unfolding locally, across the state, and in Washington, DC. • CMA released its 2015 annotated model medical staff bylaws free to members.

After soliciting physicians’ input on SB 128, CMA removed its opposition to physician aid in dying in 2015. CMA had longstanding policy in opposition to PAS and had successfully helped defeat previous efforts to legalize it in the state legislature and through the ballot. However, recognizing that views on many social issues have shifted in the years since that policy was fully debated and adopted, and aware of data suggesting that opinions within the physician community itself may have changed, CMA’s Council on Ethical Affairs and Council on Legislation reassessed CMA policy and made recommendations to the CMA board of trustees to modify its policy on PAS / PAD.

ICD-10 RESOURCES • Surviving ICD-10: An FAQ for Physician Practices • ICD-10 Transition Guide: What Physicians Need to Know • Discounted ICD-10 Education and Training • On-demand ICD-10 Overview Webinar • ICD-10 News Alerts, Webpages, Resource Centers • One-on-One Assistance Through SDCMS’s Physician Advocate • ICD-10-CM Code Set Boot Camps at SDCMS • ICD-10 Ombudsman Established Directly Resulting From CMS’s Meeting With CMA

STOPPING HEALTH PLAN ABUSES • CMA stopped a massive transfer of negotiating power from physicians to health plans by defeating AB 533. • The DOJ adopted and the Office of Administrative Law approved CMA’s recommendations that insurers be required to have clear, publicly available criteria over who is included in a network, and that insurers demonstrate comprehensive quality assurance programs in many areas related to directories and networks. • CMA filed an amicus brief in the California Supreme Court to urge a fair and just interpretation of provisions within the Knox-Keene Act that permit health plans to delegate payment responsibility to risk-bearing organizations. • CMA helped physicians understand their rights and options after Anthem again unlawfully pursued physicians for payment refunds.

YOUR  SUPPORTING OFFICE MANAGER • SDCMS Conducted Our 3rd Biennial Medical Office Salary Survey in 2015 • Congratulations, Deann Cooper, RN, SDCMS’s 2015 Results Are In! Outstanding Office Manager of the Year — Nominated by Dr. Ted Mazer, 28-year Member of SDCMSSDCMS has welcomed member physician office managers and practice administrators to participate in its private SDCMS Office Manager Forum, enabling office managers to build a community of mutual support since 2012.

official publicatio n of SDcMS January 2016

back office position

certified medical assistant

department lead

clerical position

front desk position

insurance biller

it tech

licensed vocational nurse

• Know Your Participation Status Toolkit • Exchange Resource Center • Preparing for Changes in 2015 Tip Sheet • Insurer Contacts and Qualified Health Plan Insurance Carriers • Office Placard • Understanding the Grace Period • Plan Names, ID Cards, Provider Directory Reference Guides • FAQs for Patients in English and Spanish

data entry

front office position

insurance claim tracker

medical assistant

insurance verifier

nurse practitioner

Our Medical Office Salary Survey

office manager

physician assistant

procedure scheduler

“Physicians Unite d for a


2015 SDcms Annual Report


patient collection rep

registered nurse

surgery scheduler

healthy san diego”



2015 SDcms Annual Report



BIDDING FAREWELL TO OUR LONGTIME CEO In 2015, your SDCMS physician advocate solved more than 550 SDCMS member physician problems, including saving a member $80,000 who had been chasing his ACA primary care rate increase for crossover claims since 2013; helping a member overturn the findings of a Meaningful Use audit and allowing him to keep his $18,000 incentive; assisting a member in getting his medical license renewed and saving him several weeks of not being able to practice medicine or see patients; saving a member $40,000 who was getting nowhere with his missing Medi-Cal reimbursements; and getting a group’s new physician onto their Medi-Cal contract, which was holding up his hospital privileges.

RESIDENTS & MEDICAL STUDENTS • In conjunction with UCSD, SDCMS held two “Making Your Way After Residency” workshops in 2015 with nearly 150 resident and young physicians attending. • SDCMS president, Dr. William Tseng, led the UC San Diego School of Medicine commencement and White Coat ceremonies. • Congratulations to medical student Stephanie D. Garcia for her National Medical Fellowships California Community Service-Learning Program award!


MAY 2016

After more than 14 years as SDCMS CEO, Tom Gehring retired on December 31, 2015. We thank Tom for his dedication to SDCMS’s noble vision of “Physicians United for a Healthy San Diego,” and we wish him Godspeed, fair winds, and following seas.

official publication of SDcMS OctOber 2015

InfectIous DIsease Just One Passenger Away

“Physicians United for a healthy san diego”



• San Diego Physician delivers SDCMS’s message to more than 9,000 physicians in the county every month, along with more than 400 legislators, journalists, hospitals, libraries, and others. • SDCMS published 22 issues of our “News You Can Use” e-newsletter, reaching 9,000+ recipients every two weeks.

 EVENTS & SOCIALS • SDCMS held five physician socials and networking opportunities around the county in 2015, each a rousing success! • SDCMS’s 2015 White Coat Gala was held on June 13 to honor our SDCMS Foundation, to thank outgoing president, J. Steven Poceta, MD, and to welcome incoming president, William T-C Tseng, MD, MPH. Almost 200 people attended, including Representative Scott Peters, Senator Marty Block, and Assemblymembers Lorena Gonzalez, Shirley Weber, and Rocky Chavez. • The Top Doctors celebration was held October 10 to benefit your SDCMS Foundation — almost 300 people attended.


Rent: 12% Credit Card/Bank Charges: 1% Insurance: 1% Miscellaneous Expenses: 2% Telephone: 1% Staff Time G&A: 8%



CMA Commissions

2015 SDcms Annual Report





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Physician Database



Physician Engagement


2013: 2,813 2012: 2,683 2011: 2,670 2010: 2,652

2009: 2,578 2008: 2,562

2015: 3,002 2014: 2,961

Grand Total SDCMS Membership for 2015: 5,455

2007: 2,419 2006: 2,390 2005: 2,195 2004: 2,163


Regular Physician Members: 3,002 Resident Physician Members: 1,344 Medical Student Members: 368 Retired Physician Members: 741

2003: 2,056 2002: 2,029

More than 130 physicians and office staff attended SDCMS’s seminars, webinars, and workshops in 2015: • Workshops: Advocacy Training, Breaking Bad News, ICD-10-CM (3), Leader’s Toolkit (3), Legal & Financial Literacy, Media Training, Preparing to Practice (2), Taming Outlook, Work-Life Balance • Seminars & Webinars: Covered California, Disciplinary and Termination Practices, HIPAA (2), Hiring for Your Practice, Meaningful Use, Medicare (4), OSHA, Revenue Cycle Management, Sexual Harassment, Social Media, Water Reuse & Purification Project, Worker’s Compensation


SDCMS conducted its seventh biennial physician workforce and compensation survey in 2015, yielding valuable data and insights for our San Diego County physician community, as well as local and state legislators.



classifieds PRACTICE FOR SALE PROFITABLE LASER TATTOO REMOVAL CLINIC FOR SALE: 15-year established clinic in great location with ocean view. Perfect opportunity for doctor/medical practitioner looking for their own business. Owners have developed system that removes tattoos with better results in fewer visits. Equipment includes two FDA-approved, factory maintained lasers and dermal cooler. One-year free maintenance on lasers (excluding parts) included. Facilities have plenty of power, dedicated 220 power lines per laser. New owner can use existing lasers to expand into more cosmetic, dermatology services and/or convert to medical spa. Business has outstanding reputation, first-page Google ranking. Call today! (619) 333-6296, lamar@fcbb. com. [475] PHYSICIAN POSITIONS AVAILABLE FULL OR PART-TIME BC/BE DERMATOLOGIST TO JOIN OUR TEAM: Two employment opportunities with a premier dermatology practice. One position to cover our Oceanside / Escondido / Murrieta locations, and a second separate position to cover our Murrieta / Temecula locations. Full or part-time BC/BE dermatologist to join our team. This is a busy, eight physician, three physician assistants, and seven office practice. Dermatology Specialists is well established in the local communities with a wide referral base and good patient mix. Candidate will have the flexibility of practicing general, surgical, and cosmetic dermatology. This is an excellent opportunity for a physician who is team oriented, motivated, enthusiastic, and caring to join a well-established, busy, and stable practice. We offer a generous base salary plus production incentive and benefits. This is a practice opportunity without the hassle of managing and partnership obligations. If you are interested in finding out more information concerning employment opportunities with Dermatology Specialists, Inc., please forward your CV to Jane Lisk, administrator, via fax at (760) 828-9140, via email at, or call (760) 828-9129. [494] SHARED PARTNERSHIP PRACTICE: Seeking internal medicine physician to join a shared-expense private practice partnership in Vista, California. Wonderful opportunity to join a well-established internal medicine group that has a history of over 30 years of outstanding care in the community. Established EMR system and exceptional office staff. CA license, board-certified IM physicians should send CV to or call Dene at (760) 726-2180. [492] PSYCHIATRISTS NEEDED: Full-time or part-time positions available for a well-managed program at San Diego County correctional facilities. Telepsychiatry position also available. Flexible hours with very competitive pay. Send CV to or call (619) 885-3907. [272] SEEKING EXPERIENCED, HIGHLY MOTIVATED FAMILY OR INTERNAL MEDICINE PHYSICIAN: Federally qualified health center (FQHC) clinic site in City Heights seeks an experienced, highly motivated family / internal medicine physician with a vision for the future of community medicine. San Diego Family Care operates seven clinic sites in San Diego to serve the primary care needs of our diverse communities. PCMH model operational and EHR system in place. NCQA recognized. Visit our website at sdfamilycare. org. Must have CA license. Excellent salary / benefits with retirement match. Looking for a special doctor, committed to our mission! Send CV to Diana Marquardt, MD, Medical Director, at or call (619) 321-2614. [487]

fied health center (FQHC) clinic site in Linda Vista seeks an experienced, highly motivated family or internal medicine physician with a vision for the future of community medicine. San Diego Family Care operates seven clinic sites in San Diego to serve the primary care needs of our diverse communities. PCMH model operational and EHR system in place. NCQA recognized. Visit our website at sdfamilycare. org. Must have CA license. Competitive salary/benefits with retirement match. Looking for a special doctor, committed to our mission! Send CV to Arthur “Tony” Blain, MD, MBA, FAAFP, Medical Director, at or call (858) 248-1509. [440] PHYSICIAN POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at [469] FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN WANTED FOR FAMILY PRACTICE LOCUM TENENS: One of our doctors to be on sabbatical for approximately four months, beginning 4/1/16. Busy, well-established practice located in the UTC / La Jolla area of San Diego, near UCSD. We are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. Physician to provide care for patients of all ages. Call responsibilities minor. Work four days/week. Board-certified, California-licensed MD and DO physicians interested in this opportunity should send CV to [466] FAMILY PRACTICE / INTERNAL MEDICINE PHYSICIAN WANTED for vibrant private family medical practice in San Diego. La Jolla Village Family Medical Group has been caring for pediatric, adolescent, adult, and geriatric patients for 27 years. We are located in the UTC / La Jolla area of San Diego, near UCSD, and are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidencebased chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with healthy work-life balance. This a real family practice, one of the last of its kind. We are not owned or managed by a hospital system. Excellent work environment, clean modern office suite, friendly staff with very low employee turnover. Going on three decades of continuous care for local families. Board-certified, California-licensed MD and DO physicians interested in this opportunity should send CV to [465] PRIVATE PRACTICE IM/FP OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO GOUNTY: This is an unusual opportunity to practice medicine within a well-established internal medicine group that has a history of over 30 years of outstanding care in the community. Exceptional office staff, small group setting, and very high quality patient care set this far apart from many other situations. Option for 1–2 days/week with flexible scheduling, outpatient only. Interested in board-certified IM or FP applicants with EHR experience. Please email CV to or call (619) 248-2324. [462]

PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a part-time physician. Flexible hours, strong staff, and good compensation (based on experience). Please send CV to [474]

SEEKING A FOOT/ANKLE SPECIALIST: Well-established, highly respected, four-physician group, private practice in San Diego seeking a foot/ankle specialist. Our group is expanding to meet high volume of cases and planned expansion. Potential opportunity for any established subspecialist looking for a permanent practice location. We have a broad-based primary care referral base, mature EHR, digital X-ray, ultrasound, and DME program. Interested parties, please email your CV in confidence to [461]


SEEKING EMERGENCY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician mul-

To submit a classified ad, email Kyle Lewis at SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.


May 2016

tispecialty group in San Diego, is seeking full-time BC/BE emergency medicine physicians to join our urgent care staff. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email [459] SEEKING FAMILY MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multi-specialty group in San Diego, is seeking full-time BC/BE family medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@sharp. com. [458] SEEKING INTERNAL MEDICINE PHYSICIANS: SHARP Rees-Stealy Medical Group, a 500+ physician multispecialty group in San Diego, is seeking full-time BC/BE internal medicine physicians for the South Bay. We offer a competitive compensation package, excellent benefits, and shareholder opportunity after two years. Please send CV to SRSMG, Physician Services, 300 Fir Street, San Diego, CA 92101. Fax (619) 233-4730. Email lori.miller@ [457] PRIMARY CARE JOB OPPORTUNITY: Home Physicians ( is a fast-growing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 992-5330 or email CV to Visit www. [037] PHYSICIANS NEEDED: Family medicine and pediatric physician positions currently available. Vista Community Clinic is a private, nonprofit, outpatient clinic serving the communities of North San Diego County, Riverside County, and Orange County. We have openings for full-time and part-time physicians. Current CA and DEA licenses required. Malpractice coverage provided. Full benefits packet. Forward resume to or fax to (760) 414 3702. Visit our website at EEO Employer / Vet / Disabled /AA [912] OFFICE SPACE AVAILABLE OFFICE SPACE FOR RENT WITH WELL-ESTABLISHED ORTHOPAEDIC PRACTICE: Located near Alvarado Hospital. Onsite digital X-ray. Ideal for specialties such as pain management, rheumatology, foot/ankle, spine. Interested parties, please email [493] MEDICAL OFFICE SPACE FOR RENT IN ENCINITAS: Convenient location five minutes from Scripps Encinitas Hospital. Close to 5 freeway. Features include two spacious exam rooms, private consultation / doctor’s office, lunchroom, private bathroom, and a spacious waiting room shared with one other doctor. Very affordable rent. Office located at the corner of Encinitas Blvd. and Manchester Ave. Call (858) 756-3021 or email for more information. [489] 3998 VISTA WAY, IN OCEANSIDE: Three medical office spaces approximately 2,000–2,500 square feet available for lease. Close proximity to Tri-City Hospital with pedestrian walkway connected to parking lot of hospital, and ground-floor access. Lease price: $1.75+NNN. Tenant improvement allowance to customize the suites is available. For further information, please contact Lucia Shamshoian at (760) 931-1134, ext. 13, or at [480] MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE/ SHARE IN UTC/LA JOLLA AREA: Established orthopedic surgeon seeks tenant to share office space. 4675ft2 in Chancellor Park, near Scripps Memorial Hospital. Completely rebuilt in 2009. Six exam rooms, digital Xray onsite. Beautiful finishings, spacious waiting room, conference room, break room. Ample space for support staff and a private office for physician. Available immediately, full or part time. Ideal for primary or satellite office. Excellent freeway access (1-5 and 805), first-floor suite located off lobby near main building entrance. For further information, please contact Georgana Bradley at (858) 457-0050 or at [477]

MEDICAL OFFICE / SPACE FOR RENT / SUBLEASE NEXT TO ALVARADO HOSPITAL: Bright, recently remodeled. Three exam rooms and two “doctor’s” offices, front desk area for three secretaries, and storage area. Share waiting area with a neurologist. Plenty of parking for patients and designated doctor’s parking. Easy access to the freeways and trolley. Rates negotiable. Available now. Rent whole space or part of it. Call (619) 917-7040. [476] LA JOLLA (NEAR UTC) MEDICAL OFFICE FOR SUBLEASE OR SHARE: Scripps Memorial medical office building. Great location, steps to main hospital entrance. 9834 Genesee Ave. between I-5 and I-805. Up to four exam rooms and private or shared consult office available. Please call (858) 622-9076 and ask for Jennifer. [394] MEDICAL OFFICE IN SOUTH BAY AVAILABLE TO SUBLEASE: Located next to Paradise Valley Hospital, this large, recently renovated office consists of six exam rooms and one procedure room. The office is currently utilized by orthopedic surgeons, a urologist, and a med legal specialist, but can accommodate any practice. Facility provides easy access to the PVH operating room, physical therapist, imaging center, laboratory, and wound care center, and has easy freeway access. Opportunity for orthopedic ER call at Paradise Valley Hospital and patient referrals. For more information, please contact Jeff Craven at jeff@sdmiortho. comor at (858) 245-9109. [472] MEDICAL OFFICE SPACE FOR SUBLEASE WITHIN 4,000FT2 ESTABLISHED FAMILY PRACTICE IN UTC / LA JOLLA AREA: Ideal location between I-5 and I-805. Only a few blocks from UCSD and Scripps. Spacious ground floor space with ample parking within a professional medical complex. Up to two modern, private exam / treatment rooms available, nurses station, shared or own receptionist. Clean, contemporary design, ADA compliant, built-in laboratory. Excellent, in-house referral base from four busy and respected practitioners. Ideal for OB/GYN, dermatology, aesthetic medicine, neurology, ENT, or other complimentary specialty. Please email or call (858) 999-5153. [453] 1,701FT2 MEDICAL OFFICE SPACE AVAILABLE TO SHARE IN CLASS A MEDICAL OFFICE BUILDING: Turnkey, recently remodeled, first floor in Sorrento Valley with excellent highway access and easy, free parking. Flexible schedule options. Four exam rooms. Two entrances. Reasonable rates. Email or call for more information: (619) 2188980, [444] LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] POWAY OFFICE SPACE FOR SUBLEASE: Private exam room or rooms available for one day a week or more. Ideal for physician, chiropractor, massage therapist. Low rates. Email inquiries to [173] BUILD TO SUIT: 950SF office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with six gated parking spaces, two entryways, restrooms, lighted tower sign space. Build-out allowance to $10,000 for 4–5 year lease, rent $1,800 per month gross (no extras). Contact or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: Two exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE MEDICAL OFFICE ADMINISTRATOR: We are a one-doctor private practice looking to hire a front office with previous office experience. Must have warm caring demeanor, excellent interpersonal and customer service skills. Must have good computer skills and experience with electronic medical records. Experience with Athena net is especially helpful. Other important experiences are front office administrative tasks such as operational and customer ser-

vice issues, coordinating employee resources and patient flow. Familiarity with back office task is a plus. Forward your resume and cover letter to [490]

accredited program required. Minimum two years’ experience preferred. Contract salary commensurate with experience. Please send CV/resume to [471]

PSYCHIATRIC NURSE PRACTITIONER NEEDED: For part-time or full-time work at San Diego County correctional facilities. Flexible hours and very competitive pay. Send CV to or call (619) 8853907. [273]

FNP AND PA POSITIONS AVAILABLE AS WE CONTINUE TO GROW: Full, part-time, or per-diem flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at [468]

ACCOUNTING MANAGER: The accounting manager is responsible for general accounting functions, including general ledger, month end reconciliation’s, close, and financial preparation, cash management, and oversight of accounts payable and payroll functions. The accounting manager will manage and provide guidance to the accounts payable, staff accountants, and payroll. Qualifications: Bachelor’s degree in finance / accounting; 7+ years in senior-level accounting, with three years management experience; Strong knowledge base of finance, accounting, budgeting, payroll regulations, and cost analysis in accordance with GAAP required; Preferred knowledge base within healthcare and/or grants management accounting; Preferred database experience within Great Plains and ADP. Contact Joyce Nagel at (760) 736-8737 or at [483] RAMONA HEALTH CENTER MANAGER: The Ramona health center manager is responsible for the management and operation of the day-to-day activities of the health center, including employment. The manager will maintain the mission of NCHS to improve the health status of our diverse communities by providing quality healthcare that is comprehensive, affordable, and culturally sensitive. Qualifications: Bachelor’s degree or equivalent work experience in health services administration, public health, or related field; Knowledge of medical terminology, legal and technical aspects of a medical records system, and ICD9 and CPT codes; 3-5 years’ experience in a medical, health, or social services setting; 3+ years’ management experience. Contact Joyce Nagel at (760) 736-8737 or at [484] LVN NURSE MANAGER: The LVN nurse manager is responsible for day-to-day activities of the health center. You will participate as a member of the leadership team to ensure effective quality medical services to patients. Health center manager assures that health center procedures are continually and systematically followed, patient flow is enhanced, and customer service is extended to all patients. Responsible for assisting in scheduling clinicians for optimal medical coverage. Able to maintain a high standard of confidentiality. Qualifications: High school diploma, GED or foreign equivalent; Graduate of an accredited LVN/ LPN program; Current California state licensure LVN/LPN; Current IV cert required; Current CPR/BLS American Heart Association; Two years’ experience supervising staff in a healthcare setting. Contact Joyce Nagel at (760) 736-8737 or at [485] RN — BILINGUAL WHS: The Women’s Health Services registered nurse (RN), under the direction of the director of nurses, follows medical protocols and administrative procedures. WHS RN will run a NSt/AFI clinic, doing patient education and conducting triages for the department. Will also assist in preparing patients, perform laboratory procedures, and dispense and administer medication. You will be responsible for case management, and maintain the confidentiality. Qualifications: ASN, prefer BSN; Current California state registered nurse license; CPR/BLS American Heart Association, current; Two years’ nursing experience prefer in WHS; Required bilingual in English and Spanish. Contact Joyce Nagel at (760) 736-8737 or at joyce.nagel@ [486] PHYSICIAN ASSISTANT NEEDED FOR BUSY MULTIDISCIPLINARY MEDICAL PRACTICE TO START IMMEDIATELY: Requirements: Must be CA licensed; Have high ability to work in a fast-paced environment and handle stressful situations; Must be compassionate and have great bedside manner. Please email or fax resume with salary requirements to or (858) 2021548. To learn more about our company, visit us at www. [481] PSYCHIATRIC NURSE PRACTITIONER OPPORTUNITY: South Bay and East County practice seeking a psychiatric nurse practitioner licensed to practice in the State of California. Opportunity to work with psychiatrist in primarily outpatient offices with some inpatient settings. Current professional liability insurance, current DEA certificate, current ACLS certification, and a master’s degree in nursing from an

NURSE PRACTITIONER WANTED FOR FAMILY PRACTICE LOCUM TENENS: One of our doctors to be on sabbatical for approximately four months, beginning 4/1/16. We are located in the UTC / La Jolla area of San Diego, near UCSD, and are closely affiliated with Scripps Memorial Hospital and UCSD Medicine. NP to provide care for patients of all ages. Call responsibilities minor. Work four days/week. Experienced, board-certified, California-licensed family, pediatric, or other complementary specialty nurse practitioners interested in this opportunity should send CV to [467] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email Visit [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email Visit [038] Legal Services

When the BMQA calls … Your best friend is competent counsel Call the Law Offices of Richard B. Rodriguez 33 years of experience Reasonable Rates (619) 427-7622

MEDICAL EQUIPMENT / FURNITURE FOR SALE CLEARWAVE OFFICE WAITING ROOM CHECK-IN KIOSK WITH TABLETOP STAND: (eClinicalWorks Compatible) Decrease wait times, increase collections, and improve financial performance. Liberty Tabletop Kiosk with 17-inch, built-in, all-in-one touchscreen computer with privacy filter. Intel Celeron Dual Core, E1500, 202 GHz processor, 2GB RAM, 160GB hard-drive, ID Tech swipe magnetic credit card reader mounted on right side of the screen. Copays and accounts receivable payable upon check-in. Windows 7 OS, LogMeIn Pro2, IE 9, and McAfee. eClinicalWorks kiosk software included. Original cost new $5,199. Sell for only $1,899. Email [443] EXAM PROCEDURE LIGHT IN EXCELLENT CONDITION (GENTLY USED): Works well, with 12V halogen bulb. Bought new for $225.00, asking $50. Color is white with chrome. Has flexible goose neck. Base with 4 wheels for easy mobility and long cord. Plug-in is 3 prong. Perfect for medical procedures or skin care. If interested, please call (858) 272-2021. Located in a medical center near Interstate 5. [482] MEDICAL EQUIPMENT: Two Midmark 404 exam tables (excellent condition), including extra tabletop (brand new) $400.00 each. Two TAB file cabinets (3’x5’) at $200.00 each. X-ray file cabinet (3’x6.5’) at $200.00. X-ray view box $100.00. Finger Reduction system at $200.00. Cast cutting saw at $100.00. Health O Meter Mechanical Pediatric scale (nearly new) at $100.00. All offers can be best priced. Please call (619) 298-9938 if interested. [479]




POLST e-Registry San Diego & Imperial Counties — SBAR A Community Initiative by Karl Steinberg, MD, CMD, and Alicia Muñoz, MAS, FACHE, CQA, CPHQ

S — Situation According to the California Health Care Foundation, most Physician Orders for Life Sustaining Treatment (POLST) form information is stored in paper format using a standard pink form maintained and issued by the Emergency Medical Services Authority (EMSA) of California. POLST information is completed by clinicians along with patients who wish to record medical intervention and resuscitation orders for use during an emergency. The original form is portable and should stay with the patient in healthcare settings and at home; and clinicians and decisionmakers (e.g., family) should have a copy. Yet often during an emergency the POLST form may not be readily available. Physicians and hospitals are implementing POLST solutions that are silo-specific. Forms collected and attached to the electronic health record often cannot be shared. In the current environment, there is no good way to determine the most current form if there is more than one form for a patient.


May 2016

Deficient access to POLST forms can lead to inappropriate, possibly harmful interventions not aligned with a person’s preferences. Emergency Medical Services (EMS) is the most frequent use case for the importance of POLST access. B — Background The POLST form helps guide discussions between patients, their families, their physician, and their healthcare team about their treatment wishes in instances of serious illness. POLST transforms those wishes into physician orders, which are actionable and to be respected across the continuum of healthcare settings. Physicians can now bill under the advance care planning codes (99497-99498) for completing a POLST form if more than 15 minutes (or 45 minutes) is spent discussing advance care planning — in addition to their usual evaluation and management coding. In October 2015, Governor Brown signed a bill authorizing a POLST e-registry pilot

project under the aegis of the EMSA (Senate Bill 19, Wolk). Currently, New York, Oregon, Utah, and West Virginia have registries that store, manage, and provide online access to POLST forms. EMSA and the Coalition for Compassionate Care of California (CCCC), in partnership with the California Health Care Foundation (CHCF), are working to develop the POLST e-registry demonstration. The San Diego Coalition for Compassionate Care (SDCCC) is working closely with San Diego Health Connect (our local health information exchange) and other stakeholders to respond to this request for proposal, “Pilot of a POLST eRegistry in California: Technology Platform,” and San Diego Health Connect has formed a healthcare stakeholder POLST workgroup. A — Assessment The POLST workgroup will provide the framework and requirements for a San Diego and Imperial POLST e-registry hosted by San Diego Health Connect, the public HIE. The POLST e-registry will strive to provide the most recent, accurate POLST form to healthcare providers and community members, depicting a person’s specific preferences for medical treatment and goals of care — to help San Diego County residents get the kinds of treatment they want to get, avoid getting treatments they do not want to get, and to let healthcare professionals, including first responders, have timely access to these orders. A POLST e-registry aligns with highreliability organizations striving to honor people’s preferences for treatment and care across care settings, and support has been approved by the board of directors of the Hospital Association of San Diego and Imperial Counties. R — Recommendation The San Diego County Medical Society supports POLST e-registry pilot as a community initiative. Dr. Steinberg, SDCMS-CMA member since 1995, is an Oceanside-based nursing home and hospice physician who takes his dogs to work every day. Dr. Steinberg is as well vice chair of the Compassionate Care Coalition of California and sits on the SDCMS Bioethics Commission. Ms. Muñoz is vice president of quality and patient safety at the Hospital Association of San Diego and Imperial Counties.

Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice, and we are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

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May 2016  

The May 2016 issue of San Diego Physician covers the legislative advocacy process, SDCMS's 2015 annual report, and more.

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